MEDICARE: MR. AHMED HUSSAIN MEMON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.017981	IL
2	363L00000X	Nurse Practitioner	209-017981	IL

General Provider Information

NPI Number	:	1033693742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AHMED HUSSAIN MEMON NP

Provider Business Mailing Address
First Line	:	8427 AUSTIN AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3213
Country	:	US
Telephone Number	:	224-478-2533
Fax Number	:	847-616-5563

Provider Business Practice Location Address
First Line	:	3800 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2312
Country	:	US
Telephone Number	:	866-267-2353
Fax Number	:	847-616-5563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	02/05/2026

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